A Captive Audience—and Providers—Benefit from Telemedicine

Where might be the perfect setting to launch a successful telemedicine project?

To maximize your investment in cameras and connections, you'd need a large number of patients with a mix of common yet treatable diseases. You'd need contracts with board certified specialty providers willing to devote their time. Having a single payer model would help, to simplify the revenue stream.

But, perhaps equally important, having all your patients in one location for easy access would tie the system together.

If you guessed the state prison system, you'd be right on the money.

Telehealth for the incarcerated is not a new idea. California's Department of Corrections, with its 170,000 population of adult prisoners in 33 institutions, has had such a system in place for at least 10 years, says Bonnie Noble, director of clinical operations for California Prison Health Care Services. State documents say the first project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.

Noble says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year. Most prisons are located in rural areas, such as the San Joaquin Central Valley, where specialists are in short supply.

So the state provides about 16,000 telemedicine visits with doctors in 22 specialty fields through the use of $20,000 camera systems purchased for each institution, Noble says.

Specialists in cardiology, dermatology, endocrinology, gastroenterology, infectious disease, neurology, orthopedics, psychiatry—and even transgender medicine for about 600 patients who need monitoring for hormone therapy—are available on contract with about five hospital systems, including University of California San Francisco and Riverside Community Hospital.

Not only does it reduce the risk to the public when inmates are out of the institution, it also reduces staff time to process paperwork, reduces the time the inmate must wait for care, and allows access to specialists who aren't available locally. "A dermatologist in San Diego can consult and diagnose a patient-inmate in Crescent City (at Pelican Bay State Prison some 850 miles away)," explains Noble.

Noble says the state is planning to upgrade the system to equipment that provides higher resolution, so doctors can better visualize wounds, rashes and other symptoms or facial expressions. At the prison, a nurse or another qualified provider sits with the inmate to interpret or assist in the delivery of care based on the tele-physicians' suggestions.

Other states have followed suit. According to a California legislative analyst's report from four years ago that recommended wider application of telemedicine in state prisons, 25 other states use telemedicine to provide care to inmates.

Saint Luke's Health System, an 11-hospital group with 1,321 beds in Kansas City, MO, serving Missouri and Kansas, recently announced that it has teamed up with Correctional Medical Services, Inc. and the Missouri Department of Corrections to bring telehealth to Missouri's 30,000-prisoner system.

In December, Saint Luke's began using high-resolution cameras and audio systems to connect prisoners with specialists in pulmonary medicine and wound care up to 157 miles away.

At the first encounter, Greg Howell, MD, sat in his Kansas City office behind a camera as a patient with emphysema came into another camera's view 157 miles away in Jefferson City.

"He had a mild case of emphysema, and the physician was able to listen to his lungs, his heart rate, and evaluate and adjust medications," explains Steve Kropp, director of Outreach and Telehealth at Saint Luke's.

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